Additional Diabetes Information

Additional Diabetes Information?

Diabetes affects three to five per cent of Western populations, including one million Canadians. In those with diabetes, the body's cells cannot absorb and use glucose (sugar) adequately for lack of, or resistance to, the hormone insulin. In severe, untreated diabetes the body's cells are starved of fuel for energy, sugar can't enter the cells and its level in blood may rise. The immediate dangers of diabetes are hyperglycemia - high blood sugar - and ketoacidosis, a build-up of ketone bodies in the blood which can lead to diabetic coma even death. The long term complications of the disease include growth failure in children, damage to the blood vessels, eyes, kidneys and nerves, hypertension (high blood pressure), elevated blood cholesterol, heart disease and peripheral vascular (blood vessel) disorders, especially in the feet. Management of the disease requires careful attention to diet, exercise and, when needed, medications to keep blood sugar as close as possible to the normal range.

Different types of diabetes

There are (at least) three distinct types of diabetes - Types I and II, and gestational diabetes - which arises only in pregnancy. Each type has different causes and mechanisms and requires different therapy. In North America, 80-90 per cent of those with the disease have Type II, or non-insulin-dependent diabetes mellitus (NIDDM), where the body's cells cannot respond normally to insulin. This form usually develops in middle age, mostly among the obese and under-exercised. It often responds well to dietary management, rarely requiring insulin therapy. The remaining 10-20 per cent of those with diabetes have Type I, formerly called juvenile diabetes, now termed insulin-dependent diabetes mellitus (IDDM). Fortunately, people with this form can be kept alive by the lifelong use of insulin - first isolated in 1921 by Drs. Banting, Best, Collins and MacLeod, the historic research team at the University of Toronto physiology department. In poorly-controlled diabetes, the tissues may "melt away" in a state resembling "starvation in the midst of plenty." Short of fuel (sugar), the tissues may draw on protein to make up for the lack of glucose. Alternate fuel stores may be used to the point where the person loses weight and feels tired most of the time. Serious complications may also develop, such as kidney failure, cardiovascular disease, nerve damage and eye problems. Diabetes is a leading cause of blindness in North America. Eye problems, such as diabetic retinopathy - due to burst blood vessels in the retina - may occur without warning. But the damaged retinal blood vessels can now often be sealed with laser treatment. The vision blurring that happens from time to time in those with diabetes is not related to retinal blood flow, and may vanish on its own with better blood glucose control.

Diabetes is often detected by a blood test and is confirmed by further blood tests done after fasting for 12 hours - the "fasting glucose test" - or occasionally, by a "glucose tolerance test".

The insulin connection

The body regulates the absorption of glucose (sugar) into cells and controls its level in blood with the help of insulin, a hormone produced by the pancreas. The pancreatic "beta cells" in the Islets of Langerhans secrete insulin into the blood as needed - especially after meals. Insulin signals liver, muscle, kidney and other body cells to take up glucose from blood and also encourages the removal of fat. Glucose cannot enter body cells efficiently without insulin, to aid its transport across cell membranes. Normally, insulin keeps levels of glucose in the blood within safe limits which range from 4-7 mmol/L. But if the pancreatic beta cells make too little or no insulin (as in Type I diabetes), or if the body's cells are "insulin-resistant" and cannot respond normally to it (as in Type II diabetes), the level of blood glucose may rise dangerously. Some of the excess sugar may also spill into the urine.

Insulin now comes in short-, medium-, or long-acting forms. Thanks to recombinant engineering, besides beef (cow) and pork (pig) insulin, there's now also a human variety that causes fewer skin and allergy problems. However, human insulin is more expensive than other animal-based products and provides neither better control nor fewer serious complications. (Purified human insulin is, however, advised for pregnant women with diabetes to reduce possible adverse effects on the fetus.) The action of different insulins peaks at varying times after injection and mixtures are geared to individual diet, activity and lifestyle. Many of those who need it do best with a mixture of fast- and intermediate-acting forms. Insulin requirements increase at times of stress, illness and during pregnancy.

Type I or insulin-dependent diabetes mellitus (IDDM)

Type I - formerly called juvenile - diabetes, now known as insulin-dependent diabetes mellitus, affects about one in 600 North Americans including 50,000 Canadians. It usually shows up by adolescence or early adulthood. The symptoms - frequent urination, blurred vision, unusual thirst, weight loss and irritability - may come on quite suddenly. This type of diabetes is now viewed as an autoimmune disorder in which certain antibodies attack the body's pancreatic beta cells, resulting in insulin deficiency. At diagnosis, 70-90 per cent of those with Type I diabetes have identifiable anti-insulin and anti-islet antibodies. The role of heredity remains controversial. Studies of identical twins show that if one has Type I diabetes there is a 40-50 per cent chance that the other twin will also develop it. But although a susceptibility may be inherited, unknown triggers - possibly a virus, toxin or some other environmental agent - may "trip" the autoimmune process into action. Researchers have identified genetic markers (HLA or human leukocyte antigens) that occur more frequently than usual in people with Type I diabetes.

Treatment of Type I diabetes aims to mimic or duplicate as closely as possible the body's normal control of blood sugar, with carefully timed insulin injections. Deprived of their own natural insulin, those affected rely on lifelong insulin replacement. The more regular the timing of insulin injections, the better the control. The injection site is rotated and experts suggest watching out for night-time dips or peaks in insulin action, which can go undetected during sleep. To monitor how well insulin shots are keeping blood sugar within safe limits, people with Type I diabetes must test their blood several times a day (before and after meals, before and after exercise). This is done with simple test kits, most of which register a colour change according to the amount of sugar in a drop of blood. They must also know how and when to test for ketones in their urine. Taking care of diabetes is a daily ritual, no more time-consuming than brushing one's teeth twice daily.

Type II or non-insulin dependent diabetes mellitus (NIDDM)

Once called "maturity" or "adult-onset" diabetes, non-insulin dependent diabetes mellitus tends to develop in later life, usually over age 40. By age 65, it affects one in 10 North Americans. In this form, too little insulin is produced, or the body cells are "resistant" to it. But many with Type II diabetes remain oblivious to the problem - sometimes for years - until complications appear. Owing to the diuretic effect of elevated blood glucose, frequent urination (or perhaps vision-blurring) may be the first alerting symptom.

The strongest predisposing factors for Type II diabetes are obesity and a family history of diabetes, the risks being almost directly proportional to body weight. (The disorder is rare in countries where food is scarce.) Almost 80 per cent of those diagnosed with Type II are overweight, although diabetes can sometimes develop in lean individuals. And it's a mistake to think of Type II diabetes as "mild" diabetes just because routine insulin injections aren't always needed. Many of those affected face the same devastating health complications as with Type I.

About one third of those with Type II diabetes can control the disorder by weight loss and diet alone; the rest need oral medications - which work for those whose pancreas still manufacturers some insulin - or insulin shots. Oral medications for Type II diabetes include the sulfonylureas (such as DiaBeta, Diabinese, Dimelor, Euglucon, Micronase, Orinase and others) which stimulate the pancreas into making more insulin, and the biguanides (such as Metformin), which increase tissue insulin sensitivity and induce the body's cells to take up more glucose. The medications prescribed depend on the person's blood sugar levels, weight and exercise habits. After a while, oral antidiabetic agents often lose their efficacy and insulin injections may become necessary.

Gestational diabetes (in pregnancy)

Gestational diabetes affects only pregnant women and arises in two to five per cent of pregnancies, sometimes developing then for the first and only time. Pregnant women who are obese, have a family history of diabetes or are of advancing age are at particular risk and may be screened for the condition during weeks 24-28 of gestation. Two things may trigger gestational diabetes -- the weight gain in pregnancy and the production of certain hormones (such as cortisol and placental lactogen) that alter the way insulin works, perhaps tipping a predisposed woman into a transient diabetic state. Gestational diabetes demands close adherence to diet, careful monitoring of blood sugar and, if all else fails, insulin therapy. Recent research suggests that the condition is due to enhanced resistance to insulin rather than to full-fledged diabetes and that fetal risks may have been over-estimated. But older, overweight women with gestational diabetes are at risk of producing large, post-mature newborns that may suffer some complications of prematurity. Gestational diabetes usually disappears after delivery, although it may recur in subsequent pregnancies. The Canadian Diabetes Association reports that only 30 per cent of women with gestational diabetes eventually develop the disease.

Treatment aims to minimize blood sugar swings

The cornerstone of diabetes treatment is education about the disease, regulated meal plans, weight control, adequate exercise, adherence to insulin or other medication and physchosocial counseling. A primary goal is to limit both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). Results from the largest clinical trial ever undertaken, recently completed, show that better blood glucose control, with more frequent insulin does (more closely geared to blood sugar levels), can dramatically reduce many diabetic complications.

As injected insulin cannot mimic the naturally precise and exquisite pancreatic control, in those on insulin shots the body is alternately flooded with, and starved of, insulin, resulting in fluctuating blood glucose. So, those taking medication for diabetes, especially multiple daily insulin injections, always face the possibility that an occasional excess of insulin (or other antidiabetic agent) will cause "hyperinsulinism" and transient hypoglycemia or low blood sugar. The warning signs of hypoglycemia include: irritability, trembling, faintness, clammy hands, blurred vision, mood swings, personality changes, sweating, ravenous hunger (especially for sweets), headache, dizziness, drowsiness, nausea, perhaps also a staggering gait and slurred speech. It's wise to be prepared for possible hypoglycemic bouts and carry quickly-absorbed sugary snacks. The condition is swiftly remedied by consuming something rich in sugar, such as a couple of sugar cubes or a glass of juice.

Diet plays a key role in managing diabetes

People with diabetes are advised to eat at regular intervals, without skipping meals. It's a tough regime and some, especially teenagers, need professional counseling and careful planning. When meals are delayed, people can compensate by "borrowing" from the next meal or snack (perhaps nibbling some cheese and crackers). As delays in restaurants are common, when eating out those with diabetes are advised to "have a little something" at home first. When traveling, people with diabetes may need to compensate for the extra stress and irregular meals. Going through time zones requires special vigilance in timing meals and medication.

There's still considerable debate over the best diabetic diet. But the current dogma for those with diabetes is to eat -- as recommended for everybody else -- a "heart-healthy" diet comprised of 55-60 per cent complex carbohydrates, about 12-25 per cent protein, and with 30 per cent or less of the total calories as fat. Most experts suggest that saturated fats should be reduced, with an increased intake of complex carbohydrates. They argue that a diet rich in complex carbohydrates (once forbidden for diabetics), moderates the post-meal rise in blood sugar and improves glucose tolerance. Complex carbohydrates may also increase sensitivity to insulin, making smaller amounts effective. The Canadian Diabetes Association recommends that carbohydrates be eaten primarily in the form of legumes, grains, breads and pastas. Fibrous foods such as oat bran, lentils, beans, peas and whole and cracked wheat are promoted and may slow the rise in blood sugar.

Exercise also crucial for good control of diabetes

Physical activity creates a short-term improvement in tissue-sensitivity, both to insulin and other antidiabetic agents. But the improved insulin sensitivity disappears within days of discontinuing an exercise program. A research team at Stanford University that followed nearly 6,000 men for 14 years found that those who regularly played a sport, walked or otherwise kept physically active were less likely than their sedentary counterparts to develop diabetes. Their study also showed that the risks fell by six per cent for every 500 kilocalories of energy expended per week -- approximately the amount used by a man of average size in jogging or swimming for an hour, or in walking five miles (8 km). In the past decade, several large studies linking a sedentary lifestyle to Type II diabetes, have indicated that vigorous exercise (such as fast walking, running or swimming) may exert greater protection than just moderate activity. Studies of populations in Western Samoa and the South Pacific showed a lower rate of Type II diabetes in rural islanders who led strenuous lives than in those who moved to urban areas and became less active. Harvard investigators also found Type II to be less common among women who had been athletes in college than among non-athletic alumnae. But blood sugar levels must be more carefully monitored when undertaking an exercise routine.

Recent developments

Researchers have come up with imaginative ideas for delivering insulin with suppositories, vaginal inserts, nose drops and so on, but so far without success. Oral insulin is out of the question, as stomach acids destroy the hormone. For blood sugar monitoring, a machine is being developed to detect glucose levels through the skin, which would avoid the need for finger-pricking. As autoimmune processes destroy the insulin-producing beta cells, treatment with cyclosporin (an immuno-suppressant widely used in transplant operations) started early can induce remission in 10 to 20 per cent of young people with Type I diabetes. But unfortunately, its side-effects (kidney damage, for instance) outweigh the inconvenience of daily insulin injections. New treatments, such as interleukin-4 (an immune-defense chemical) are also being investigated -- with the promise of only twice weekly insulin injections.

Ideally, those with diabetes could benefit from transplanted, insulin-producing cells. But since rejection is a major problem, researchers are trying to protect transplanted cells by micro-encapsulation (surrounding them with a coating) to defend them against the host's attacking cells. In one University of Toronto study, the transplanted cells are enclosed in a capsule of alginate (seaweed extract). The protective membrane allows free passage of nutrients and hormones, including insulin, but keeps out components that could cause rejection.

In conclusion: managing diabetes and living with it, not for it, is an art, not a science. One of the best things you can do is take regular exercise, such as walking 1-2 miles daily, every day. Happily, even many with "poor" control remain well decades after diagnosis. Others may develop complications while maintaining relatively good control. Genes (heredity) play a role in the way people respond to the disorder, but most live very productive lives despite the disease.

For more information: contact your local Diabetes Association Office or email the author.

Disclaimer: This article in no way should be taken as “medical advice” on any product, condition or course of action, nor does it constitute in any way “medical advice” endorsing any specific product, specific result, nor any possible cure for any condition or problem. This article is meant as a source of information upon which you may base your decision as to whether or not you should begin using any vitamin, mineral and/or herbal supplement for better health, or begin using a “greens” product as a dietary supplement.

If in doubt, or if you have questions, you should consult your physician and, if possible, consult a second physician for a possible different opinion. The author does not bear any responsibility for your decisions nor for the outcome of your actions based upon those decisions.

Loring Windblad has studied nutrition and exercise for more than 40 years, is a published author and freelance writer.

This article is Copyright 2005 by http://www.organicgreens.us and Loring Windblad. This article may be freely copied and used on other web sites only if it is copied complete with all links and text, including the Authors Resource Box, intact and unchanged except for minor improvements such as misspellings and typos.

Diabetes: Another Information Source?

Additional Diabetes Information?